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CNAA / Theses / 2017 / May /

Anomalies of the Female Genital Organs: Optimisation of Diagnosis and Treatment

Author: Mișina Ana
Degree:doctor habilitat of medicine
Speciality: 14.00.01 - Obstetrics and Gynecology
Scientific consultants: Olga Cerneţchi
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Eva Gudumac
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care


The thesis was presented on the 16 May, 2017
Approved by NCAA on the 31 May, 2017


Adobe PDF document1.41 Mb / in romanian


CZU (618.51:618.1-007):[(618.1-089+616-089.15+616-079.89):616-007.2]

Adobe PDF document 16.00 Mb / in romanian
300 pages


The thesis is 217 pages long and consists of an introduction, six chapters, and synthesis of the results, general conclusions, practical recommendations, 17 tables, and 170 figures. The bibliography includes 384 sources. Forty seven papers were published based on the thesis topic.

Research area:obstetrics and gynaecology Aim of the study: to improve treatment outcomes, quality of life and reproductive function for patients with congenital anomalies of the female genitalia based on the optimization of diagnosis, systematization and evaluation of short- and long-term results. Objectives of the study: to investigate the radiological anatomy of the pelvic organs in MRKH syndrome, as well as the structure of associated anomalies of the urinary and the musculoskeletal systems. To evaluate the results of peritoneal colpopoiesis and progressive dilatation in the correction of vaginal agenesis and to study morphological and immunohistochemical features of the neovagina. To systemise the structure of diseases of uterine rudiments and of ovaries in MRKH syndrome. To determine the structure, anatomical variations, diagnosis and surgical correction peculiarities of vaginal malformations and to establish the associated uro-genital system abnormalities. To determine and compare the diagnostic accuracy of 3D Ultrasound/MRI in the diagnosis of different variants of symmetric uterine anomalies. To develop and improve the technical aspects of uterine anomalies surgery. To study the long-term results of surgical correction of uterine and vaginal anomalies. To identify the features of the reproductive function, pregnancy and delivery after reconstructive operations and surgically uncorrected uterine anomalies.

Research novelty and originality:The existence of radiological options of the anatomy of pelvic organs in the MRKH syndrome was confirmed. In relation to the patients with the MRKH syndrome, the research established that after peritoneal colpopoiesis, anatomical and functional results were achieved in 100% of cases. The features of ERα expression in the neovagina tissues were determined for the first time based on the immunohistochemical estimations. The study demonstrated the occurrence of rare tumours of the ovaries in the MRKH syndrome in the late period after vaginoplasty. It was proved that in the structure of the vaginal obstructive anomalies with hematocolpos, statistically, imperforate hymen was observed more frequently compared to the HWW syndrome and complete transverse vaginal septa (CTVS). The anatomic variants of the HWW syndrome and CTVS were established. The 3D Ultrasound/MRI turned out to be highly informative in the diagnosis of types of uterine anomalies (Cohen's kappa index = 1). The features of diagnostics and surgical correction of different classes of uterine anomalies were revealed. The research proved the existence of female genital tract anomalies, which have not been previously described in the literature.

The main applied scientific problem solved is to create a methodology for determining the variants of anomalies of female genital organs, for which optimal approaches have been identified in differential diagnosis and individualized surgical correction with maximum restoration of sexual (quality of life) and reproductive functions.

Theoretical significance: The variants of the radiological anatomy in MRKH syndrome were described. The morphological and immunohistochemical features of the neovagina after peritoneal colpopoiesis were discussed. The morphological features of uterine rudiments in the MRKH syndrome were described based on electron microscopy. The study contains a detailed presentation of the anatomical variations of the HWW syndrome. Details were provided on anatomic characteristics of HWW and CTVS. The morphological and immunohistochemical features of the uterine septa and rudimentary horn in class U4 anomalies were delineated. This is for the first time in the world medical literature when the anomalies of female genitalia are described: (1) obstructive uterine septum (Robert's uterus) with complete longitudinal vaginal septum; (2) unicornuate uterus (U4) in conjunction with thrombophilia.

Applicative value of the work: The principles of diagnosis, classification and surgical correction of various classes of congenital anomalies of the genitalia were outlined. Implementation of the scientific results: New methods of diagnosis and treatment of patients with MDA were introduced based on this research in the Departments of Operative Gynaecology, Endocrine Gynaecology, Paediatric Gynaecology, Paediatric Urology, Paediatric Emergency Surgery, Pathology of Pregnancy and Radiology of the Institute of Mother and Child (Chisinau, Republic of Moldova), and also into the teaching process of the Department of Obstetrics and Gynaecology No.2 and the Department of Paediatric Surgery, Orthopaedics and Anaesthesiology at the University of Medicine and Pharmacy “N. Testemiţanu”. The study received copyright protection in four categories and there are 17 proposals for implementation in the medical practice.